Provider Demographics
NPI:1205219722
Name:TALLEY, KASEY (NP)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:TALLEY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13198 JAMES MADISON HWY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-2808
Mailing Address - Country:US
Mailing Address - Phone:540-672-3010
Mailing Address - Fax:540-672-5713
Practice Address - Street 1:13198 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-2808
Practice Address - Country:US
Practice Address - Phone:540-672-3010
Practice Address - Fax:540-672-5713
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVH820AMedicare PIN